Provider Demographics
NPI:1710368584
Name:HAWATMEH, SARA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HAWATMEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KAKISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2355 DOUGHERTY FERRY RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3325
Mailing Address - Country:US
Mailing Address - Phone:314-835-4873
Mailing Address - Fax:314-336-6475
Practice Address - Street 1:2355 DOUGHERTY FERRY RD STE 410
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3325
Practice Address - Country:US
Practice Address - Phone:314-835-4873
Practice Address - Fax:314-336-6475
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.150547207R00000X
CAC84524207R00000X
MO2018022611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine